How Public Opinion Is Informed by National Origins

Policy makers may consult public opinion when rethinking social security. Factors that influence public opinion usually go beyond personal interests and values, however. It is frequently argued that public institutions indirectly influence the opinion-forming process within society by shaping expectations and preferences and, thus, legitimate their own performance. In short, opinions on public institutions depend on the expectations of the population that are again shaped by the system itself. New research approaches that take into account this disruptive factor are necessary, when investigating which systems in Europe perform better over others and how the internalisation of values and experiences conveyed by institutions, i.e. socialisation, affects public opinion.

In a country-comparative study, Simone M. Schneider, researcher at the Max Planck Institute for Social Law and Social Policy, makes an attempt to unravel this dual relationship between institutions and public opinion in the field of healthcare by examining healthcare evaluations of the foreign born, i.e. persons originally from Europe now residing in a European country in which they were not born. Schneider finds out that socialisation processes indeed exert a crucial influence on public opinion: The experience and knowledge of alternative institutional arrangements serve as frames of reference and fundamentally shape the opinions on healthcare of the foreign born.

So far, research has indicated that two main aspects are decisive for a positive evaluation of healthcare: high financial resources and high density of general practitioners. Surprisingly, characteristics such as the amount of out-of-pocket spending or the density of and access to specialist care are less important in the evaluation of healthcare. However, the examination of attitudes of the foreign born lends relevance to further evaluation criteria.

In general, the following applies to those Europeans who reside in countries they were not born in: the better healthcare institutions perform relative to those in the country of origin, the higher their healthcare ratings. Criteria such as access to medical care then become crucial in the evaluation process. If the choice of a general practitioner is less restrictive and the consultation of a specialist is comparably easier in the country of residence than in the country of origin, healthcare ratings will be higher as well. Also, the experience with different public financing schemes has an impact on the assessment. For instance, tax financed national health care systems are rated poorer on average, if the respondent used to live in a compulsory contributory health insurance system.

The foreign born evaluations of the healthcare system are also determined by other factors, such as the prevailing public opinion in the country of residence: if the healthcare system is positively perceived by the majority of the population, the attitudes of newcomers will be positively affected in turn. In addition, the study shows that respondents are, at the beginning, generally more positive about public institutions in the country of arrival than many nationals. However, this initial optimism diminishes over time and foreign born tend to adopt attitudes similar to the majority population.

Overall, the study suggests that origin has a discernible influence on the formation of opinions on public institutions, with the respective country of origin often providing an important frame of reference. This becomes evident when examining the institutional criteria that influence the formation of attitudes of the foreign born. Knowledge and experience of alternative healthcare arrangements fundamentally shape individual attitudes. Most likely, these aspects will become increasingly important for the public opinion-forming process as mobility across European countries is rising. 

Publication:

Schneider, Simone M.: Beyond endogeneity in analyses of public opinion: Evaluations of healthcare by the foreign born across 24 European countries, in: PLOS ONE, 2020.